Provider Demographics
NPI:1104449313
Name:ANGEL WINGS HOME CARE INC
Entity type:Organization
Organization Name:ANGEL WINGS HOME CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:CDP
Authorized Official - Phone:815-770-7060
Mailing Address - Street 1:44 MONROE ST UNIT 7
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-7157
Mailing Address - Country:US
Mailing Address - Phone:815-770-7060
Mailing Address - Fax:815-230-5501
Practice Address - Street 1:44 MONROE ST UNIT 7
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-7157
Practice Address - Country:US
Practice Address - Phone:815-770-7060
Practice Address - Fax:815-230-5501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-21
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health